If it turns out to be a huge mess and a boondoggle because it is not well planned, as many people think, then it will just cost an extra few billion dollars to the 49% who actually pay all the taxes.

Right. Not to pick on you specifically Buz, but this is a common theme I've noticed. It's never phrased that if major problems arise with a government program, it will simply be a logistical and budgetary setback. No, it's implied that poor people are not only sucking freely off of the burdened taxpayers, but now are to blame for a flawed program, too.

Wouldn't life in this country be so much better if we could just post a big "survival of the fittest" sign at the door of all the shuttered social services offices and allow that 49% to keep a few more bucks for themselves? A condo on the gulf coast and a new Range Rover would sure be sweet, who gives a fuck about those in real need? They should've tried harder, I guess. The world needs ditch-diggers, too. At least that's what all that Ayn Rand bullshit preaches. Ambition and profits over all else. If we have to look at poor people, let's at least keep them quiet.

When you hear the phrase "class warfare", this situation is a prime example. Resentment of those with means toward those without them. Yes, a comparative few pay the taxes for the comparative many. That's the way it is, whether you choose to resent it, or to envision lowly street-people picking your pocket for a flu vaccine, or not.

Plantation politics. Don't bother Massa, he's dining at the country club, and doesn't care to hear your complaints about the living conditions. He pays for them, you know!

Does that include children who have no income, old people on Social Security who don't get enough to pay taxes on after a lifetime of being taxpayers, and stay at home moms? How do they arrive at the 49% figure? Does that count payroll taxes, property taxes, sales taxes, gasoline taxes?

If you have a family of five and you are the sole wage earner, does that mean that 80% of your family are freeloaders?

Not all money that is classified as welfare is targeted at the poor. There are large outlays to corporations, including tax breaks on the federal, state, and local level. When corporations don't pay tax in a city, someone has to take up that slack. Giving a big corporation a break on property taxes, water and utilities means that everyone else has to pay more.

There is no government budget classification for welfare. When pie charts show welfare at 12%, where it is now, that includes all items listed in the federal budget as "Income Security." A pie chart of how that is divided shows that the majority of income security money is not targeted specifically at the poor.

The area in red is money which goes directly to the poor. The blue area is money that goes to other people in behalf of the poor. The green area includes money available to all people, not just the poor. The poor aren't living it up at our expense. They are struggling to make ends meet. In Georgia, where Buz and I live, people have to work for TANF (Temporary Assistance for Needy Families.) The program requires the person applying for aid to have a child under the age of 19. This was formerly Aid to Dependent Children. It is now a temporary program that requires the recipient to work and train for a job.

Other states have different requirements for public assistance, of course. Most of these people are people who have had very hard lives. They aren't dining on steak and lobster at taxpayer expense and driving Cadillacs like the woman in the Reagan myth. They are, for the most part, people who are victims of the economy. The bail out of the banks did nothing for the poor. Only the rich benefited.

Like LadyX said in her post, this is plantation politics. The unemployed poor are being played off against the working poor, who are being played off against the middle class. We have had a massive upward movement of wealth in this country, from the poorest upward, but the media manages to keep the discussion on the poor and unemployed.

Stave The Beast implementation - it's worked very successfully for the cocksuckers who thought it up and have spent the last 30 years of applying it to this country.

For readers who don't know what I'm talking about: Ever since Ronald Reagan, the GOP has been run by people who want a much smaller government. In the famous words of the activist Grover Norquist, conservatives want to get the government "down to the size where we can drown it in the bathtub."

But there has always been a political problem with this agenda. Voters may say that they oppose big government, but the programs that actually dominate federal spending -- Medicare, Medicaid and Social Security -- are very popular. So how can the public be persuaded to accept large spending cuts?

The conservative answer, which evolved in the late 1970s, would be dubbed "starving the beast" during the Reagan years. The idea -- propounded by many members of the conservative intelligentsia, from Alan Greenspan to Irving Kristol -- was basically that sympathetic politicians should engage in a game of bait-and-switch.

Rather than proposing unpopular spending cuts, Republicans would push through popular tax cuts, with the deliberate intention of worsening the government's fiscal position. Spending cuts could then be sold as a necessity rather than a choice, the only way to eliminate an unsustainable budget deficit.

And the deficit came. True, more than half of this year's budget deficit is the result of the Great Recession, which has both depressed revenues and required a temporary surge in spending to contain the damage. But even when the crisis is over, the budget will remain deeply in the red, largely as a result of George W. Bush-era tax cuts and unfunded wars. In addition, the combination of an aging population and rising medical costs will, unless something is done, lead to explosive debt growth after 2020.

So the beast is starving, as planned. It should be time, then, for conservatives to explain which parts of the beast they want to cut. And President Barack Obama has, in effect, invited them to do just that, by calling for a bipartisan deficit commission.

Many progressives were deeply worried by this proposal, fearing that it would turn into a kind of Trojan horse -- in particular, that the commission would end up reviving the long-standing Republican goal of gutting Social Security. But they needn't have worried: Senate Republicans overwhelmingly voted against legislation that would have created a commission with actual power, and it is unlikely that anything meaningful will come from the much weaker commission Mr. Obama established by executive order.

[Paul Krugman]

And hey...Dubya and his republican majority congress (in the 1st 6 years of this century) ratcheted Starve the Beast up, by starting two forever wars. One was 'pre-emptive' and both have cost this country trillions of borrowed Chinese capital, with the budgets and the bills being kicked down the road each year by that same congress. And the Democratic led congress didn't have the fucking balls to call it what it was and address it immediately when they took control in 2007.

America spends so much gawddamned money (borrowed) on the weapons to wage wars which we have had to go out and fucking start - to even make the spending of the last thirty years - mean anything.

While we cut services for our veterans who served (and many of them came home disabled for the rest of their lives...mentally and physically).

It has been said that the Obamacare plan is modeled after the government health plan in Canada. An interesting article from The Fraser Institute about the effectiveness of Canada's healthcare system. Fraser Institute on Canadian Healthcare System

Consider waiting lists. In 2011, the median wait time from general practitioner referral to treatment by a specialist was 19 weeks in Canada. Despite substantial increases in both health spending and federal cash transfers to the provinces over the past 15 years, the 2011 wait time was 60 per cent longer than the 1997 median wait time of 11.9 weeks. In 2011, patients waited more than double the 9.3 weeks they would have waited in 1993. Our indicators are getting worse, not better.

•Canadians were the most likely to wait four months or more for elective surgery; and were less likely to wait less than one month for elective surgery than all but Sweden;•Canadians were the most likely to wait six days or longer to see a doctor or nurse when sick, and were the least likely (tied with Norway) to receive an appointment the same day or next day;•Canadians were the most likely to wait two months or more for a specialist appointment and least likely to wait less than one month for a specialist appointment; and•Canadians were the least likely to wait less than 30 minutes and most likely to wait four hours or more for access to an emergency room

Access to medical technologies is also relatively poor in Canada. In a recent comparison of inventories of medical technologies per one million people: in MRI machines, Canada ranked 15th of 26 OECD nations for whom data was available; 17th of 27 nations in CT scanners; 11th out of 24 in PET scanners; and 19th of 21 in lithotripters. Research also shows that Canada’s relatively small inventory of medical technologies consists of many old and outdated machines. Clearly, Canada’s relatively high expenditures neither buy quick access to care, nor do they buy high tech health care equipment and services for the population.

Government restrictions on medical training, along with a number of other policies that affect the practices of medical practitioners, have also taken their toll on Canadians’ access to health care. A recent comparison found Canada ranked 26th of 32 OECD nations for which data was available in the number of physicians per thousand population. It should come as no surprise that Statistics Canada determined that nearly 1.9 million Canadians aged 12 or older could not find a regular physician in 2009.

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I hope the system that goes into place in the States learns from our northern neighbors. Some may say that long wait times are ok in comparison to not seeing a physician at all, that's a legitimate arguement. Before this plan goes into effect, I hope our politicians will take the time to work on all facets of what's coming. Not to muddle through it for 10 years trying to figure out what works and doesn't, all at our expense. Take the time to get it right the first time.

When the debate is lost, slander becomes the tool of the loser. Socrates

I am not a fan of the healthcare plan, the way it is written and planned out, at all.

However, someone I know just gave me a sales pitch for a business idea about creating a medical services business specifically tailored to this Obamacare plan. If Obamacare stays in effect this could be a sweet profitable venture. I may have to invest in this. I am still reading over his proposal and so far it looks very promising.

Lafayettemister, I have just read your very interesting post about the Canadian Health Care System.

I have a cousin who is the administrator for a medical clinic in Montana. He told me that over half of their patients are Canadians that cross the border and pay out of their own pocket for medical treatment because of the long waits in Canada.

it's the biggest joke going .only people it benefits is the insurance companies.nothing is better than something in this case. it would be fine if odumba actually overhauled healthcare . all he did was totally fuck up a systwm already screwed to beging with,reallyhow is odumbacare good for the country.it's no good at all.another problem with it.is the illegals don't have to purchase.why the hell not we give them everything else ,doesn;t make any sense ,oh wait thats the only way he gets re-elected is with the dead and illegals voting for him since he stopped deporting them.... I mean really Odumba is worse than even carterwas,but romney isn't the answer either really this is the best we could do for a president and presidential canidate.we are totally fucking crewed then as a country and how did pelosi and reid and the rest of them even get elected .they all need thrown out ,and we need to put real people in ofice's also the supreme court has to go to lifeterm what a joke half of them a freaking senile and they are making laws for this country .no life term 65 and done.period ,lets talk about term limits hell yes thats how we stop new people from being corrupted and becoming corrupt career ploticians . it this is the best we can do as the U.S.A.we'll might as well vote for mickey freaking mouse he would do a better job then odumba or romney.

for me when i hear opponents to the affordable healthcare act speak i have one question: what is so splendid about a healthcare system )physicians, nurses, hospitals, clinics, pharmaceutical companies and health insurance companies) where people are forced to have benefits in order for some families to pay for a catastrophic illness? we in the good old usa have all seen this - from benefit dinners and auctions to the collection cans left on the counters of grocery and convenience stores - my question is why is this necessary if we have "the best healthcare system in the world"? to me this signals that the system, if not broken, needs a lot of help.

That's a false dichotomy. If Option 1 of healthcare reform is O-care and Option 2 is the former status quo, then Option 3 is to get the federal government disconnected and let the states do what they will do without federal interference in the arena of contract law. Not a single supporter of O-care can come up with a compelling case for why that wouldn't be a better option. It just won't happen because we've already made the mistake of centralizing too much authority under the federal government. It's only constitutional because it's an abuse of the commerce clause and the power to tax. We would need to disconnect Medicare and allow businesses to quit providing group plans and states to start providing group plans, but Congress won't give up what it gains the authority to regulate. For that reason we're going to head down the same rat hole that Europe's countries went down before they were forced to take the radical step of forming the EU.My latest story is too hot to publish. My most recent story before that is Even Stranger In Lust

I just don't understand.The USA is one of the wealthiest countries in the world and yet it cannot look after its poorest citizens and denies them medical aid when ill. Almost every other country in the civilised world has a health service that is free at the point of delivery. Trillions of dollars are spent on weapons of mass destruction which will never be used yet are quite happy to allow people to die because they are poor. A friend of mine recently had a successful life saving operation because he was operated on within 30 mins of collapsing., Nobody went through his pockets looking for his credit card or proof that he could pay for the operation and for weeks in hospital. Thank god he lived the UK and not in America.

Comparing the US to the countries of Europe is an apples to oranges comparison. The EU doesn't have centralized health care or centralized social security, but the people of the EU countries are free to move to and work in and invest in and buy from any of the other EU countries. That provides a natural check on how generous those countries will be with their taxpayers' money. Too much generosity will result in an exodus of capital and productivity. So the bread and circuses mentality of democracy is constrained by the fact that productive people have over 20 nations competing for them.

Where will the productive people of the US go when the pressure to make the plans more generous results in pandering from Congress? The answer is simple. To war in some form or another. That's how the Europeans did it before they formed the EU.

Over here we have what's known as the National Health Service. Established by Aneurin Bevan in 1947 as a 'cradle to the grave free to all at the point of need' establishment it has served our nation well - or so I'm told - in past times.

Not so now. Successive governments have eroded bit by bit that service to the point where it is now not even a joke anymore. Our original NHS was established just after world war II when the country was on it's knees ... and it worked bringing free health care to all.

Surely a country like USA with all it's infinite resources and ability to put men on the moon 43 years ago can manage to look after the health of its people - or does personal greed of the rich creep into it as seems to have happened here and to our healthcare system.

The reason the NHS has declined in its ability to remain generous is because the UK joined the EU and now has to do what it takes to keep all the productive people and investment capital from going to other EU countries and to keep all the sick people from the other EU countries from moving in and taking advantage of the generosity. In short, you have competition for governance at the national level because you wisely did not centralize such entitlements under the EU government.

We could have similar competition in the US at the state level, but we've already chucked that out and we're heading for authoritarian hell. It's easy to blame the problems on the greed of the rich, but what about the greed of the poor for something they haven't earned? That's how the rich look at it, and if we try to enslave them to serve our purposes, their capital will sift right through our grasp and go elsewhere. That lesson has been learned over and over and over and we really don't need to keep running that experiment. We know the result is catastrophic economic stagnation.

Skill and talent and competence and capital go wherever there is opportunity for profit and go away from wherever they're treated as common wealth. The countries of Europe formed the EU and deliberately put the EU member states into direct economic non-violent competition with each other as a direct result of runaway spending on social programs which caused a cycle of warfare by causing economic stagnation and emigration of labor and capital.

You do know the ACA was modeled after Romney's plan that he put into action in Mass. right???

That's irrelevant. What you can get away with at a state level is entirely different than what you can get away with at a national level. Romney knows that, even if he's prone to caving in. He'll want to get reelected in four years and if he doesn't find some way to end O-care, that probably won't happen.

It was my understanding that this was a bill designed to help the lower end of the spectrum, and didn't include the rich, and congress because they have no trouble finding health insurance. How do you include those elite categories with the lower categories unless you move to a universal health insurance? What would you do instead of this plan? It's easy to pick at the bad parts, the parts that need improvement in the future, but I haven't seen you post a better solution to the problem.

The better solution to the problem is the solution that won't result in runaway entitlement spending. We know where that spending takes us. Adding more is like stepping on the gas as you drive toward the cliff. Our international competition is salivating over the advantages they'll gain from this. We're violating a very basic law of human behavior. When you make it more expensive to work and cheaper not to work, you'll get less work.

The solution is obvious, but politically unrealistic. Get the federal government completely out of the business of funding and regulating health care and health insurance. Let the natural competition between states do the job.My latest story is too hot to publish. My most recent story before that is Even Stranger In Lust

I know all the Republicans have a very fiery rash over the 'mandate', but something had to be done. To say that we should have gone about this a different way, or "reform the entire system to reduce costs" is nothing more than an empty platitude. I'm a young person, but I've read enough to know that we Americans have seen this mess building over many, many years. The costs have been skyrocketing, the exclusion of certain kinds of patients (including women in general) has worsened, and who benefits? Everyone but the people that the "healthcare industry" is supposed to, in theory, be serving: The Patients.

Yet, nothing happened. Democrats made a couple of runs at it, but bipartisan support for the status quo halted it. And from the Republicans? Nada. Only platitudes and head nods in response to criticism, as any reasonable person could see that something had to be done. Then the Affordable Care Act comes around, and you hear Republicans squawking two different messages. 1) "Yes, of course something must be done (all of a sudden it's a huge and urgent issue to them too, somehow), but we have to step back and look at the system as a whole." and 2) "America has the greatest health care system in the world!" (cue: everyone outside the small wealthiest subset trying to choose between outrage and laughter at the absurdity of that proclamation).

I know I sometimes don't sound like it, with the opinions I state in here, but I'm really not some bleeding heart closet-communist that wants to see us all fitted for jumpsuits and bar-code tattoos. But there are some things about orthodox free-market conservative thought that, to me, and with respect to realism in society, are just too far gone. One of which is the idea that we, as a giant, diverse, and increasingly economically stratified mega-nation, should live out some Ayn Rand "survival of the fittest" fantasy healthcare scenario, letting for-profit insurance companies ply their trade without regulation or obligations, and hope against all logic and predictable capitalist behavior that our least-moneyed, most-vulnerable, least traditionally insurable citizens will somehow not get thoroughly fucked in the ass, then sent a bill that they can never hope to pay for their trouble. Because, see, that's what's happening now. There's a lot more to the ACA than the mandate, and much of it comes to us in the name of decency. Look any woman in the eye and tell her that maternity costs shouldn't be covered. Tell a cancer survivor that they don't deserve insurance. Because we damn sure know that Blue Cross' shareholders don't want to see it happen! And why would they? It costs money to keep people alive, let alone heal them.

And yes, there's a lot of potential flaw in Obamacare, admittedly, but as open minded as I try to be, I simply draw the line at idealizing a society where the weakest among us aren't cared for. Hiding behind the philosophical stance of "nobody should obligate us to help others" is both revealing and a total cop-out on human decency and civility.

Are we interested in talking about shoring up our (increasingly large) bottom end? It seems that we, as a country, generally aren't, unless it's to bitch about all the lazy people, welfare queens, and scamsters. The side that opposes Obamacare vehemently does raise some good points, but what they do not raise is the only thing that matters: a viable plan of their own, and the political motivation to explain and try their damnedest to enact it. Even at this late date, they fall into the same two camps- either arguing for another course of action that to this point doesn't exist in any form, or that what we have now is the way to go forward, only with LESS obligations to society. The first insults our collective intelligence, the second is insane.

The better solution to the problem is the solution that won't result in runaway entitlement spending. We know where that spending takes us. Adding more is like stepping on the gas as you drive toward the cliff. Our international competition is salivating over the advantages they'll gain from this. We're violating a very basic law of human behavior. When you make it more expensive to work and cheaper not to work, you'll get less work.

The solution is obvious, but politically unrealistic. Get the federal government completely out of the business of funding and regulating health care and health insurance. Let the natural competition between states do the job.

As part of your "international competition" I'm not sure what you think I'm salivating over in this. I already know that despite (or in my mind, because of) having one of the most free-market healthcare systems among the developed nations, the US pays more per capita than any other nation in the world on healthcare costs. So how could this system possibly hurt you competitively?

There's a very strong marketing reason for why the free market doesn't cause lower costs for patients. It's called the elasticity of demand. Or in this case, the demand is inelastic. What inelastic demand means, is that the demand for a service shows relatively little change no matter what you charge, so there's no incentive to lower prices. If anything, there's incentive to raise them. Hospitals know that a person is not going to decline cancer treatment, or open heart surgery, or any life saving procedure, because of the cost. It's a choice of find the money, or die.

You could make a bit of a case that health insurance has a little more elasticity to it, as people do have the alternative choice of having no insurance and paying their medical bills themselves as they come up. But since both the insurance company and the individual still have to pay the healthcare providers for the life saving procedures, so it's not going to cut down the actual costs of treatment.

As part of your "international competition" I'm not sure what you think I'm salivating over in this.

The reduction in international competition for medical professionals that will eventually result from it is just one example of the effects of centralization.

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I already know that despite (or in my mind, because of) having one of the most free-market healthcare systems among the developed nations, the US pays more per capita than any other nation in the world on healthcare costs.

The federal government has already interfered heavily in the healthcare markets and run the costs up drastically. By tying the provision of health insurance to employment, what would normally be a 4-party system (insured patient, insurer, doctor, state regulator) became a 6-party system (insured patient, insurer, doctor, employer, state regulator, federal regulator). That provided perverse incentives. For example, the insurer markets his products to employers instead of to the insured and the employee does less to control demand as a result.

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So how could this system possibly hurt you competitively?

It's a question of what it will do to our entire economy to have the federal government so directly involved in such a large sector of it. The level of federal interference in the healthcare market will only grow from this point as members of Congress respond to the demands of the wanty and attempt to produce solutions that have the appearance of being "fair". That has been shown over and over in countries all around the world. There is no reason to believe that the US will be immune to the problems caused by centralization of the control of these markets. Our economy will stagnate and we will attract less foreign capital, fewer talented immigrants, and fewer skilled immigrants. Our people will become less productive as they decide to drop the yoke or pull less on the gravy train that more people will pile onto.

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There's a very strong marketing reason for why the free market doesn't cause lower costs for patients. It's called the elasticity of demand. Or in this case, the demand is inelastic. What inelastic demand means, is that the demand for a service shows relatively little change no matter what you charge, so there's no incentive to lower prices. If anything, there's incentive to raise them. Hospitals know that a person is not going to decline cancer treatment, or open heart surgery, or any life saving procedure, because of the cost. It's a choice of find the money, or die.

Why would you assume that putting control of these markets in state hands is the same as leaving it in the hands of the free markets? The states would provide something that Europe benefits from, competition for governance within a common labor market. That competition has a balancing effect. Investors and jobs leave places where collectivists demand too much, turning those places into economic backwaters until they reject excessive pandering for bread and circuses.

I agree we had to start somewhere, but we ignored the lessons of history and went in the wrong direction. History shows us that a weak central government with strong protections for individual rights out-competes countries with a strong central government and weak protections for individual rights. Allowing our state governments to be the arena for evolving the best practices of balancing productivity against the natural tendency of voters to demand more from government is consistent with remaining globally competitive. I rate the likelihood of that happening now at way way way lower than the breakup of the US.

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I know all the Republicans have a very fiery rash over the 'mandate', but something had to be done. To say that we should have gone about this a different way, or "reform the entire system to reduce costs" is nothing more than an empty platitude. I'm a young person, but I've read enough to know that we Americans have seen this mess building over many, many years. The costs have been skyrocketing, the exclusion of certain kinds of patients (including women in general) has worsened, and who benefits? Everyone but the people that the "healthcare industry" is supposed to, in theory, be serving: The Patients.

Yet, nothing happened. Democrats made a couple of runs at it, but bipartisan support for the status quo halted it. And from the Republicans? Nada.

That's because the only solution offered is the anti-competitive collectivist solution, centralization under the federal government. That solution ignores the need of the US to remain globally competitive, if it is to survive as a sovereign nation. The only solution that would work against the breakup of the US or some other loss of sovereignity is the decentralization of what we already have. It would have been political suicide for the Republicans to demand decentralization, because the American people are too naive to understand the need for it. It would have involved removing any federal requirements for the provision of health insurance by employers. It would have involved shifting Medicare to state control. It would have involved cutting taxes so that states could raise taxes. We know that this solution would work as surely as we know that the voters would reject any party that proposed it.

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I know I sometimes don't sound like it, with the opinions I state in here, but I'm really not some bleeding heart closet-communist that wants to see us all fitted for jumpsuits and bar-code tattoos. But there are some things about orthodox free-market conservative thought that, to me, and with respect to realism in society, are just too far gone. One of which is the idea that we, as a giant, diverse, and increasingly economically stratified mega-nation, should live out some Ayn Rand "survival of the fittest" fantasy healthcare scenario, letting for-profit insurance companies ply their trade without regulation or obligations, and hope against all logic and predictable capitalist behavior that our least-moneyed, most-vulnerable, least traditionally insurable citizens will somehow not get thoroughly fucked in the ass, then sent a bill that they can never hope to pay for their trouble. Because, see, that's what's happening now. There's a lot more to the ACA than the mandate, and much of it comes to us in the name of decency. Look any woman in the eye and tell her that maternity costs shouldn't be covered. Tell a cancer survivor that they don't deserve insurance. Because we damn sure know that Blue Cross' shareholders don't want to see it happen! And why would they? It costs money to keep people alive, let alone heal them.

But that isn't what's happening now. What we have now is a set of perverse incentives imposed by federal government regulations that are warping free markets. The level of collectivism that we already have is playing itself out in higher costs, job exportation, loss of competitiveness in global markets, increased federal debt, and the false belief that the federal government is a viable source of "fairness" in the form of coerced charity. Is there a particular reason that the Montana, California, Iowa, etc. can't handle the needs of their people? I think not. There is only an assumption that it is the proper role of a national government to provide a "right to healthcare", despite the fact that history has shown us this bankrupts nations.

The state option is very simple. Move Medicare to state governments. Get rid of federal requirements for employer-supplied group insurance plans and allow states to create state-supplied group plans. Let states decide what to do about providing care to those who don't opt to pay premiums for the state supplied plans. Let competition between states for investment capital and productive workers determine which state-society the individual wants to belong to or invest in.

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The side that opposes Obamacare vehemently does raise some good points, but what they do not raise is the only thing that matters: a viable plan of their own, and the political motivation to explain and try their damnedest to enact it. Even at this late date, they fall into the same two camps- either arguing for another course of action that to this point doesn't exist in any form, or that what we have now is the way to go forward, only with LESS obligations to society. The first insults our collective intelligence, the second is insane.

Including the state plan that I mentioned above, there are actually two viable plans but both are currently politically dead in the water. That's because the American people are too politically and economically naive to see the need for them and demand that we get back to a weak central government with strong protections for individual rights.

When the inevitable happens, we'll either end up with war/revolution or with the second of the two. That would be the North American Union, a treaty-based weak central government similar to the EU that will not have any centralization of entitlements but would provide common labor, investment, and consumer markets from Panama to the North pole.

Good stuff, 1ball. Thanks for the response. And what you predict may well happen; nobody knows for sure, least of all me. And I definitely agree that having insurance tied to employment is hair-brained. But what I keep coming back to is beyond the question of how much the federal government is or is not meddling in the private insurance game. What I can't get my head around is how anyone would expect insurance coverage to become more, not less, inclusive without having their hand forced by the government. And that goes back to a debate about capitalism, really. How is the idea that a truly free market would be beneficial for all really accepted on any level above the theoretical? To be specific about healthcare: how would we expect for-profit corporations to affordably insure child-bearing women, or patients with congenital defects, or survivors/battlers of chronic and invasive diseases? How do the least powerful in our society not end up under the wheel, if the companies in question are not forced at some point to act in ways that might be counter to bottom-line profitability?

It's a similar argument to the environment. Putting aside the political specifics about the EPA (which I know to be a hot-button issue unto itself), who among us can say with a straight face that without some degree of regulations, that large corporations would not mercilessly deface the environment to whatever degree that it increases their bottom-line number? Sure, you can trot out the argument that with everything laid-bare, people can make a value choice to punish polluting companies through lack of commerce, but that's not realistic. People want their shit from Wal-Mart and Monsanto, because it's cheap. They don't care about the environmental impact of those companies' activities nearly as much as they care about cheap paper towel rolls. And those companies don't give two shits about the environment, or any degree of common, big picture good either. They care about their profits, as that's the purpose that their shareholders have tasked them with.

With insurance, who's going to look out for those left out? In a totally free market, how do patients win if and when the actuaries cut a wide swath through the population and determine that large subsets of people need to be insured only at exorbitant rates? You want to know how I'd quantify "exorbitant"? I'll be happy to forward you a private insurance quote I got: 21 year old healthy female, one child. It's a fucking joke, really. Who looks out for me, the "free market"? That's laughable.

Good stuff, 1ball. Thanks for the response. And what you predict may well happen; nobody knows for sure, least of all me. And I definitely agree that having insurance tied to employment is hair-brained. But what I keep coming back to is beyond the question of how much the federal government is or is not meddling in the private insurance game. What I can't get my head around is how anyone would expect insurance coverage to become more, not less, inclusive without having their hand forced by the government.

The key to that is group plans. There are several states that make sure everybody is eligible for some form of group plan. They don't call it that, but everybody is eligible and that makes it a statewide group plan. Insurers will price their group plans so they can make a profit within the regulatory framework they operate in. So if a state says every group plan must be available to every resident of the state, the plans will be priced accordingly. Then the only problem the state has is coming up with the premiums, copays, etc. for those who can't afford them.

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And that goes back to a debate about capitalism, really. How is the idea that a truly free market would be beneficial for all really accepted on any level above the theoretical? To be specific about healthcare: how would we expect for-profit corporations to affordably insure child-bearing women, or patients with congenital defects, or survivors/battlers of chronic and invasive diseases? How do the least powerful in our society not end up under the wheel, if the companies in question are not forced at some point to act in ways that might be counter to bottom-line profitability?

Under pure capitalism, nothing would stop a group of like-minded people from pooling their resources and either self-insuring or purchasing a group plan which the insurer then pools with its other group plans and thus spreads the risk. Then the insurer negotiates group rates with providers. This group could then include or exclude anyone they want. That's because they would have freedom of association, the right to associate or not associate with whomever they please. That's essentially what employer group plans are and they could exist within pure capitalism. The problem we have now is that employer group plans so dominate the market (due to federal interference) that other options can't compete with them.

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It's a similar argument to the environment. Putting aside the political specifics about the EPA (which I know to be a hot-button issue unto itself), who among us can say with a straight face that without some degree of regulations, that large corporations would not mercilessly deface the environment to whatever degree that it increases their bottom-line number? Sure, you can trot out the argument that with everything laid-bare, people can make a value choice to punish polluting companies through lack of commerce, but that's not realistic. People want their shit from Wal-Mart and Monsanto, because it's cheap. They don't care about the environmental impact of those companies' activities nearly as much as they care about cheap paper towel rolls. And those companies don't give two shits about the environment, or any degree of common, big picture good either. They care about their profits, as that's the purpose that their shareholders have tasked them with.

Within pure capitalism, there are courts and there are rights. If you have a right to something and a corporation violates that right, then the courts are your recourse. But when you have a resource that is, by necessity, held in common (egs. air and water), there is a theory of government called minarchism that accepts the need for permitting authorities. Minarchism is between anarchism and totalitarianism. It defines a proper amount of government at a proper level of government, so it would have local, state, federal, and theoretically global government with a decreasing emphasis on control and an increasing level of autonomy for individuals. If a local government violates your rights, a higher government steps in and regulates the local government's behavior, but if it fails to do so, it's very easy to get away from a local government, so by voting with your ability to leave (also called voting with your feet) an overly authoritarian local government experiences a loss of people to tax and regulate.

One thing people often forget about markets is that there are also markets for governance. The right to walk away from a failing society is a powerful incentive for that society not to fail. Collectivists love to push authority up to higher levels because they hate competition. It's hard to walk away from a country because other countries have immigration laws.

Here's the thing collectivists always conveniently forget. Countries all over the world will gladly accept immigration of rich people, highly skilled people, and investment capital. There is competition for governance at the national level, but nations cherry pick just like insurers cherry pick. That's why collectivism at the national level produces misery for the poor and the low and unskilled labor.

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With insurance, who's going to look out for those left out? In a totally free market, how do patients win if and when the actuaries cut a wide swath through the population and determine that large subsets of people need to be insured only at exorbitant rates? You want to know how I'd quantify "exorbitant"? I'll be happy to forward you a private insurance quote I got: 21 year old healthy female, one child. It's a fucking joke, really. Who looks out for me, the "free market"? That's laughable.

Because insurance is essentially a contract, contract law, which is a province of state law, is a natural fit for regulating it. If a state tries to regulate both the price and the terms of insurance contracts to the point where no insurer will attempt to compete there, the state is free to self-insure to the extent necessary to entice insurers back into the state market. The state would do this at the risk of failing to remain competitive with other states for productive people and investment capital.

So, you're free to go to another state. Your insistence that you should be allowed to remain within your state and get the coverage you want at a rate that you believe is fair is an example of magical thinking. Individuals don't have that authority and using your vote to force that option through your federal government will only succeed in making it less competitive. So, if you believe your state is failing you in that respect, you have 49 other choices and you can become an economic refugee from the state that is failing you. Those other choices will display a range of control over what you can get. Try Michigan. They have a not-for-profit BCBS that can't turn you down. You might not be able to find a job there though. They've been having trouble competing for investment capital and they've been depopulating. Are the insurance laws and the stagnating economy connected? If they are, then imagine the havoc at the national level.

I saw this in the paper this morning and thought it was funny. Hold onto your hat cause 1 out of every 5 people are going to bitch until they're blue in the face. Thing is, it won't take long cause they smoke.

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